Würdinger Michael, Schweiger Victor, Rajman Katja, Di Vece Davide, Gilhofer Thomas, Ghadri Jelena R, Templin Christian
University Heart Center, Department of Cardiology, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.
Eur Heart J Case Rep. 2024 Sep 11;8(9):ytae451. doi: 10.1093/ehjcr/ytae451. eCollection 2024 Sep.
Spontaneous coronary artery dissection (SCAD) is the most important cause of acute coronary syndromes during pregnancy and in the post-partum period and involves a spontaneous intimal tear or intramural haematoma of a coronary artery. Pregnancy-associated SCAD accounts for a minority of SCAD cases but is associated with a high rate of adverse events.
We present a series of three cases with pregnancy-associated SCAD. All patients presented with acute coronary syndromes in the post-partum period, between 12 days and 5 months after delivery. They all had additional conditions that are associated with SCAD, such as fibromuscular dysplasia and migraine. The management of one patient was uncomplicated, however, the courses of the other two were characterized by adverse events. One presented after an out-of-hospital cardiac arrest, the other presented with multivessel SCAD and developed progression and recurrence of SCAD during follow-up. In conclusion, the patients could be successfully treated conservatively and were in good condition at their latest follow-ups.
This case series highlights the wide range of clinical courses that could exist in pregnancy-associated SCAD, from a benign manifestation to a life-threatening condition. Importantly, those patients are at an increased risk for acute and late adverse events.
自发性冠状动脉夹层（SCAD）是妊娠期间和产后急性冠状动脉综合征的最重要原因，涉及冠状动脉的自发性内膜撕裂或壁内血肿。妊娠相关的SCAD占SCAD病例的少数，但与高不良事件发生率相关。
我们报告了一系列三例妊娠相关SCAD病例。所有患者均在产后12天至5个月期间出现急性冠状动脉综合征。她们都有与SCAD相关的其他病症，如纤维肌发育不良和偏头痛。其中一名患者的治疗过程无并发症，然而，另外两名患者的病程以不良事件为特征。一名患者在院外心脏骤停后就诊，另一名患者患有多支血管SCAD，并在随访期间出现SCAD进展和复发。总之，患者经保守治疗成功，在最近一次随访时情况良好。
本病例系列突出了妊娠相关SCAD可能存在的广泛临床病程，从良性表现到危及生命的情况。重要的是，这些患者发生急性和晚期不良事件的风险增加。
